Renal Cell Carcinoma 2005: New Frontiers in Staging, Prognostication and Targeted Molecular Therapy

Lam, John S.; Shvarts, Oleg; Leppert, John T.; Figlin, Robert A.; Belldegrun, Arie S.

doi:10.1097/01.ju.0000165693.68449.c3

Cited by 326 publications

(237 citation statements)

References 61 publications

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“…Renal cell carcinoma frequently leads to synchronous or metachronous metastases 1,2 and has an estimated agestandardised mortality in Europe of 2·6%. 3 For synchronous metastatic renal cell carcinoma, cyto reductive nephrectomy in combination with treatment with interferon alfa resulted in a signifi cant improve ment in median overall survival compared with treatment with interferon alfa alone.…”

Section: Introductionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

287

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Section: Introductionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

287

205

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“…At first presentation, 45% of patients will have localised disease, 25-30% will have locally advanced disease with lymph node or local organ involvement and around 25% patients have metastatic disease [2,3]. In the past, nephrectomy was offered mainly as a means of palliation to relieve the pain from local infiltration or haematuria when the conservative measures failed.…”

Section: Introductionmentioning

confidence: 99%

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Khochikar

2016

Indian J Surg Oncol

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Renal cell carcinoma accounts for 3% of adult solid malignant tumours. Approximately 25% of the patients present with metastatic disease at presentation. In the era of immunotherapy (interferon alpha-2b and interleukin-2), studies showed significant survival benefit with cytoreductive nephrectomy (CRN) followed by interferon alpha-2b than interferon alpha 2-b alone. Introduction of targeted therapies (vascular endothelial growth factor receptor-tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors) in 2005 generated a great interest in the management of metastatic renal cell carcinoma (mRCC) as these drugs exhibited tumour shrinkage in the primary tumour as well as in the metastatic site/s. Though there is no level 1 evidence, many studies have shown the usefulness of cytoreductive nephrectomy along with targeted therapy as against to targeted therapy alone. This review is aimed at the rationale behind the cytoreductive nephrectomy in mRCC, the current evidence and what is in store for the future. A detailed search on the management of mRCC was carried out on MEDLINE, Embase, CANCERLIT and Cochrane Library databases using the key words Bcytoreductive nephrectomy^, Bimmunotherapy^and Btargeted therapy^since 1980 till 2015. Original articles, review articles, monograms, book chapters on metastatic renal cancer and textbooks on urologic oncology, oncology and urology were reviewed. Various international guidelines on this issue were also studied. An identical search was performed using the American Society of Clinical Oncology Abstract database. Trials in the progress or recently completed that were relevant to this paper were identified through clinicaltrials.gov. The latest information for new articles ahead of publication was last accessed in November 2015. CRN has remained an integral part to the management of metastatic renal cell carcinoma mainly for the patients with good performance status, life expectancy of more than 12 months and in the absence of adverse prognostic factors. It had shown measurable survival benefit in the era of immunotherapy (CRN + immunotherapy vs. immunotherapy alone). In the era of targeted therapy, many studies have shown significant survival benefit with CRN + targeted therapy. However, there is no clear level 1 evidence to support this. The ongoing trials (CARMENA and European Organisation for Research and Treatment of Cancer SURTIME) would perhaps guide us in the way in which we should manage mRCC disease in the future. Maybe we may find some answers on the issues of the effectiveness of targeted therapy, the timing of CRN and sequencing these treatment arms once the results of these ongoing and future trials are through.

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“…18 Several other reports showed similar findings. 10,12,[19][20][21] Among several studies regarding RCC surveillance, the latest postnephrectomy recurrence in the lungs, abdomen, and bone was 67, 97, and 144 months, respectively. 9,12,18,20 Recommended surveillance will include clinical assessment, blood biochemistry, and chest x-ray every year.…”

Section: Recurrence Patterns For Pt1 Tumoursmentioning

confidence: 99%

“…10 As such, these variables should be noted because they contribute important prognostic information. RCC with collecting duct carcinoma, medullary carcinoma and tumour with elements of sarcomatoid dedifferentiation exhibit higher metastatic potential.…”

Section: Prognostic Variablesmentioning

confidence: 99%